Head injury and anisocoria on a cruise ship

A previously healthy 65-year-old female passenger presented on the 3rd day of her voyage with a small facial laceration after she fell and hit her forehead, following sudden blurred vision and dizziness. When the ship's doctor noticed that one pupil was much bigger than the other, he feared intracranial bleeding and considered helicopter evacuation. Her symptoms had started shortly after she had removed a transdermal scopolamine patch from behind her ear. Getting scopolamine from her hands in direct contact with the eye surface caused mydriasis. To prevent it, after handling the patch, the hands and the application site should have been washed thoroughly with soap and water and dried. Only time was needed for the dilated pupil to normalise.